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Screening for Multidrug-Resistant Bacteria in Patients after Transfer and Emergency Admission: A Strategy for the Prevention of Inter-Hospital Transmission of Pathogens

Yoshiaki SHIKAMA, Megumi YAMASHITA, Naoki YAMAGUCHI, Yuuichi ICHIKAWA, Yuuichi SHIMIZU, Toshiko RIKUKAWA, Kazuhide AKIBA and Tomoyuki IMAGAWA
Infection Control and Prevention Service, Kanagawa Children's Medical Center

In our hospital, active screening has been initiated to prevent the transmission of multidrug-resistant bacteria. This screening was performed in patients transferred from other hospitals, and those with emergency admission previously hospitalized elsewhere. Patients were informed regarding this screening by the attending physicians using the instruction form. The screening was performed by obtaining rectal swabs on the day of admission. Target bacteria were carbapenem-resistant Enterobacteriaceae (CRE), vancomycin-resistant Enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA). We used selection culture media for each of these bacteria. Upon detection of colonies on the CRE selection media, we additionally performed confirmation testing to identify carbapenemase-producing Enterobacteriaceae (CPE). From December 2016 to November 2017, 260 screening tests were performed in 245 patients. Positive results were as follows: CPE (2 cases, 0.8%), VRE (0 cases), and MRSA (23 cases, 8.8%). Both cases with CPE were transferred from other hospitals for surgical operations. Contact precautions were maintained from admission to discharge, including during the presence of these patients in the operating theater.
We sufficiently investigated the burden of the laboratory staff and economic support and explained the necessity of this screening to the physicians and nursing staff prior to the initiation of the screening. Thus, there was no obvious confusion since the initiation of the screening. The detection of CPE-positive cases on admission indicates that this screening procedure is effective in preventing the transmission of multidrug-resistant bacteria between hospitals.

Key words:multidrug-resistant bacteria, carbapenem-resistant Enterobacteriaceae, vancomycin-resistant Enterococci, active screening


Received: September 6, 2018
Accepted: October 29, 2018

34 (1):62─66,2019

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